User login
LAS VEGAS — Behavioral therapies can break the habits and misconceptions that cause chronic insomnia, provided that psychiatric or medical problems are not at play, Dr. Bashir Chaudhary said at a meeting on primary care sponsored by the Southern Medical Association.
Among patients with chronic insomnia (lasting longer than 6 months), the cause is psychiatric in about 35% of cases, psychophysiologic in 15%, related to use of drugs or alcohol in 12%, restless legs syndrome in 12%, and sleep apnea in 6%, said Dr. Chaudhary, emeritus professor of medicine at the Medical College of Georgia, Augusta, and director of the Georgia Sleep Center at the college.
In the absence of medical and psychiatric problems, chronic insomnia may be caused by psychophysiologic factors, in which the patients' anxiety about lack of sleep becomes a big part of the problem.
“These are people who are stressed about sleep all day long,” Dr. Chaudhary said. “They become obsessively worried about it.” Such patients often have conditioned themselves to experience insomnia in their own sleeping environment; if they sleep elsewhere—in another room or at another place—they often have no problem falling or staying asleep.
Other forms of insomnia can typically be swiftly corrected by addressing direct causes, but psychophysiologic cases can often take more effort on the part of the patient and the physician. “Most of the time I spend in cognitive therapy is with these patients,” he said, adding that behavioral techniques and lifestyle guidelines can be effective.
One behavioral therapy approach is stimulus control, which aims to decrease cues for nighttime arousals and focus on cues that help induce sleep. Some key recommendations include:
▸ Go to bed only when sleepy.
▸ Get out of bed if not asleep within 20 minutes.
▸ Wake up at the same time every day. “This is the most important,” he said.
▸ Do not take naps.
Sleep restriction therapy is another effective technique. Dr. Chaudhary advised asking patients how much sleep they get during a typical night, adding about 2 hours to that, and having them restrict themselves to that length of time in bed. Patients should be instructed to wake up at their regular time, but to go to bed at the time that would provide the allocated amount of sleep. If, after several weeks, patients report getting good quality sleep at least 85% of the night, then add increments of about 15 minutes. But if they are not getting the 85%, then further restrict the sleep time.
A metaanalysis of studies shows that nonpharmacologic therapies are highly successful in insomnia, with techniques improving sleep onset in 81% of cases, reducing sleep latency by 35 minutes, and resulting in 74% extension of sleep maintenance (Am. J. Psychiatry 1994;151:1172-80).
Ten Commandments of Good Sleep
As part of his cognitive therapy, Dr. Chaudhary offers patients his “Ten Commandments of Good Sleep”:
1. Thou shalt not stay in bed too long.
2. Thou shalt avoid daytime naps.
3. Thou shalt maintain the circadian cycle.
4. Thou shalt avoid stimulants after lunch.
5. Thou shalt not take a “toddy” before bedtime.
6. Thou shalt not go to bedhungry.
7. Thou shalt not smoke.
8. Thou shalt exercise regularly.
9. Thou shalt keep the bedroom at a comfortable temperature.
10. Thou shalt keep the noise down.
LAS VEGAS — Behavioral therapies can break the habits and misconceptions that cause chronic insomnia, provided that psychiatric or medical problems are not at play, Dr. Bashir Chaudhary said at a meeting on primary care sponsored by the Southern Medical Association.
Among patients with chronic insomnia (lasting longer than 6 months), the cause is psychiatric in about 35% of cases, psychophysiologic in 15%, related to use of drugs or alcohol in 12%, restless legs syndrome in 12%, and sleep apnea in 6%, said Dr. Chaudhary, emeritus professor of medicine at the Medical College of Georgia, Augusta, and director of the Georgia Sleep Center at the college.
In the absence of medical and psychiatric problems, chronic insomnia may be caused by psychophysiologic factors, in which the patients' anxiety about lack of sleep becomes a big part of the problem.
“These are people who are stressed about sleep all day long,” Dr. Chaudhary said. “They become obsessively worried about it.” Such patients often have conditioned themselves to experience insomnia in their own sleeping environment; if they sleep elsewhere—in another room or at another place—they often have no problem falling or staying asleep.
Other forms of insomnia can typically be swiftly corrected by addressing direct causes, but psychophysiologic cases can often take more effort on the part of the patient and the physician. “Most of the time I spend in cognitive therapy is with these patients,” he said, adding that behavioral techniques and lifestyle guidelines can be effective.
One behavioral therapy approach is stimulus control, which aims to decrease cues for nighttime arousals and focus on cues that help induce sleep. Some key recommendations include:
▸ Go to bed only when sleepy.
▸ Get out of bed if not asleep within 20 minutes.
▸ Wake up at the same time every day. “This is the most important,” he said.
▸ Do not take naps.
Sleep restriction therapy is another effective technique. Dr. Chaudhary advised asking patients how much sleep they get during a typical night, adding about 2 hours to that, and having them restrict themselves to that length of time in bed. Patients should be instructed to wake up at their regular time, but to go to bed at the time that would provide the allocated amount of sleep. If, after several weeks, patients report getting good quality sleep at least 85% of the night, then add increments of about 15 minutes. But if they are not getting the 85%, then further restrict the sleep time.
A metaanalysis of studies shows that nonpharmacologic therapies are highly successful in insomnia, with techniques improving sleep onset in 81% of cases, reducing sleep latency by 35 minutes, and resulting in 74% extension of sleep maintenance (Am. J. Psychiatry 1994;151:1172-80).
Ten Commandments of Good Sleep
As part of his cognitive therapy, Dr. Chaudhary offers patients his “Ten Commandments of Good Sleep”:
1. Thou shalt not stay in bed too long.
2. Thou shalt avoid daytime naps.
3. Thou shalt maintain the circadian cycle.
4. Thou shalt avoid stimulants after lunch.
5. Thou shalt not take a “toddy” before bedtime.
6. Thou shalt not go to bedhungry.
7. Thou shalt not smoke.
8. Thou shalt exercise regularly.
9. Thou shalt keep the bedroom at a comfortable temperature.
10. Thou shalt keep the noise down.
LAS VEGAS — Behavioral therapies can break the habits and misconceptions that cause chronic insomnia, provided that psychiatric or medical problems are not at play, Dr. Bashir Chaudhary said at a meeting on primary care sponsored by the Southern Medical Association.
Among patients with chronic insomnia (lasting longer than 6 months), the cause is psychiatric in about 35% of cases, psychophysiologic in 15%, related to use of drugs or alcohol in 12%, restless legs syndrome in 12%, and sleep apnea in 6%, said Dr. Chaudhary, emeritus professor of medicine at the Medical College of Georgia, Augusta, and director of the Georgia Sleep Center at the college.
In the absence of medical and psychiatric problems, chronic insomnia may be caused by psychophysiologic factors, in which the patients' anxiety about lack of sleep becomes a big part of the problem.
“These are people who are stressed about sleep all day long,” Dr. Chaudhary said. “They become obsessively worried about it.” Such patients often have conditioned themselves to experience insomnia in their own sleeping environment; if they sleep elsewhere—in another room or at another place—they often have no problem falling or staying asleep.
Other forms of insomnia can typically be swiftly corrected by addressing direct causes, but psychophysiologic cases can often take more effort on the part of the patient and the physician. “Most of the time I spend in cognitive therapy is with these patients,” he said, adding that behavioral techniques and lifestyle guidelines can be effective.
One behavioral therapy approach is stimulus control, which aims to decrease cues for nighttime arousals and focus on cues that help induce sleep. Some key recommendations include:
▸ Go to bed only when sleepy.
▸ Get out of bed if not asleep within 20 minutes.
▸ Wake up at the same time every day. “This is the most important,” he said.
▸ Do not take naps.
Sleep restriction therapy is another effective technique. Dr. Chaudhary advised asking patients how much sleep they get during a typical night, adding about 2 hours to that, and having them restrict themselves to that length of time in bed. Patients should be instructed to wake up at their regular time, but to go to bed at the time that would provide the allocated amount of sleep. If, after several weeks, patients report getting good quality sleep at least 85% of the night, then add increments of about 15 minutes. But if they are not getting the 85%, then further restrict the sleep time.
A metaanalysis of studies shows that nonpharmacologic therapies are highly successful in insomnia, with techniques improving sleep onset in 81% of cases, reducing sleep latency by 35 minutes, and resulting in 74% extension of sleep maintenance (Am. J. Psychiatry 1994;151:1172-80).
Ten Commandments of Good Sleep
As part of his cognitive therapy, Dr. Chaudhary offers patients his “Ten Commandments of Good Sleep”:
1. Thou shalt not stay in bed too long.
2. Thou shalt avoid daytime naps.
3. Thou shalt maintain the circadian cycle.
4. Thou shalt avoid stimulants after lunch.
5. Thou shalt not take a “toddy” before bedtime.
6. Thou shalt not go to bedhungry.
7. Thou shalt not smoke.
8. Thou shalt exercise regularly.
9. Thou shalt keep the bedroom at a comfortable temperature.
10. Thou shalt keep the noise down.